Diagnosing tetanus

A confident diagnosis can usually be made if someone has recently had a wound or similar injury and has painful muscle spasms and muscle stiffness.

A spatula test can help confirm tetanus if there is any doubt about the diagnosis. It involves inserting a spatula into the back of your throat. The spatula will cause a gag reflex and you will try to push the spatula out of your mouth if you have the infection. If you do have the infection, the spatula will cause your throat muscles to spasm and you to bite down onto the spatula.

Treating tetanus

If you have a deep wound that could become contaminated by the tetanus bacteria and you have been vaccinated, you will be given a medication called tetanus immunoglobulin (TIG) as a precaution.

If you have not been vaccinated and develop a tetanus infection, you will need to be admitted to hospital for treatment. Treatment usually involves a combination of medications, such as antibiotics, muscle relaxants and antitoxins, to combat the effects of the infection.

A ventilator (a machine to assist with breathing) can be used to help prevent suffocation.

Most people survive the infection, although it can take up to four months to make a full recovery.

Causes

Tetanus is caused by the Clostridium tetani bacterium.

Clostridium tetani spores can live for a long time outside the body and are widespread in the environment. They are commonly found in the manure of animals such as horses and cows, and in contaminated soil.

After they enter the body, the tetanus bacteria quickly multiply and release tetanospasmin, a type of poison known as a neurotoxin. If tetanospasmin enters the bloodstream, it can spread around the body, causing the symptoms of tetanus to develop.

Neurotoxins block the nerve signals that are sent from the brain to the spinal cord and then on to the muscles. This causes the muscle spasms and muscle stiffness associated with tetanus.

Cuts and wounds

One of the most common ways the tetanus bacteria enter the body is through a cut or a puncture wound. Even minor puncture wounds, such as piercing your skin with the thorn of a rose, could allow the bacteria to enter your body.

Tetanus bacteria thrive and breed in places where there is little or no oxygen. This is why the infection often occurs in deep cuts and wounds. To help prevent a tetanus infection developing, always ensure that cuts and wounds are thoroughly cleaned.

Other entry points

As well as entering the body through cuts and wounds, the tetanus bacteria can also enter through:

lacerations – tears or splits in the skin caused by blunt trauma such as a blow to the skin, or a sharp object such as a knife or broken glass

abrasions – wounds caused by friction damage, such as the type of wound you would get after falling off a bike and scraping your knee

If you are travelling to a remote area where medical services may not be easily accessible, and you had your last tetanus vaccine more than 10 years ago, you need to have a booster dose (even if you have already had the full five doses). This is done as a precaution, in case you get a wound that is vulnerable to a tetanus infection and medical care isn't available.

Read more about the tetanus vaccine.

Injecting drug users

People who inject illegal drugs such as heroin or methamphetamine have an increased risk of developing tetanus. Drug dealers often mix these types of drugs with a chemical called quinine. Quinine can be contaminated by the tetanus bacteria.

Diagnosis

Diagnosing tetanus is usually straightforward because the symptoms are easily recognised. Few other conditions cause painful muscle spasms like tetanus.

A confident diagnosis can usually be made if someone has recently had a wound or similar injury and has painful muscle spasms and muscle stiffness.

Spatula test

A spatula test can help confirm tetanus if there is any doubt about the diagnosis. It involves inserting a spatula into the back of your throat.

If you do not have the infection, the spatula will cause a gag reflex and you will try to push the spatula out of your mouth. However, if the tetanus infection is present, the spatula will cause your throat muscles to spasm and you will bite down onto the spatula.

Treatment

It is important that tetanus is treated quickly to prevent complications from developing.

There are two types of treatment for tetanus:

preventative treatment - for people who are thought to be fully or partially vaccinated against tetanus and who have an injury that makes them vulnerable to a tetanus infection

symptomatic treatment - for people who have developed the symptoms of an active tetanus infection

Preventative treatment

Wounds that are vulnerable to a tetanus infection are called tetanus-prone wounds.

Tetanus-prone wounds

Tetanus-prone wounds include:

wounds or burns that required surgery to repair, but access to surgery was delayed for six hours or more

wounds or burns that cause a significant amount of tissue loss

puncture injuries, particularly if they may have become contaminated with soil or manure

wounds that contain foreign bodies, such as an animal’s tooth

severe bone fractures that may have left the bones vulnerable to infection

wounds and burns in patients who have systemic sepsis (a fall in blood pressure as a result of a serious bacterial infection)

Medication called tetanus immunoglobulin (TIG) is recommended if you have a tetanus-prone wound and there is a high risk that it could be contaminated by tetanus bacteria. This might be the case if the wound came into contact with soil or animal waste.

The use of TIG is recommended even if your vaccinations are up to date. There may be a very small chance that the vaccine did not give you total immunity against tetanus.

Tetanus immunoglobulin

Tetanus immunoglobulin (TIG) is a medication that contains antibodies that kill the tetanus bacteria. Antibodies are infection-fighting cells. Tetanus immunoglobulin is given as an injection into a muscle and gives immediate, short-term protection against tetanus. It is thought to be safe to use in pregnant and breastfeeding women.

After having tetanus immunoglobulin, you are likely to have some short-term discomfort at the site of the injection. Other side effects are thought to be uncommon but may include:

Muscle relaxants

Muscle relaxants are a type of medication that help relax the muscles. They are often used when treatment with sedatives is withdrawn (sedatives can be addictive so they are not usually recommended as a long-term treatment).

You will be given muscle relaxants to stop your symptoms returning when your dose of sedatives are reduced.

Neuromuscular blocking agents (NBAs)

Neuromuscular blocking agents (NBAs) are a type of medication that block nerve signals sent from the brain to the muscles. This leads to an inability to move certain muscles (paralysis), which can be useful in people with severe muscle spasms and stiffness.

A neuromuscular blocking agent called vecuronium is usually prescribed. Vecuronium causes paralysis of the muscles used for breathing, so assistance with breathing is provided before it can be given.

Preventing further spread of neurotoxins

Tetanus immunoglobulin can be used to prevent the tetanospasmin neurotoxin causing further damage and disruption to your nervous system. Antibiotics such as penicillin (or metronidazole if you are allergic to penicillin) are also used to try to kill any bacteria and prevent any further toxins being released.

Surgery

If a tetanus-prone wound is particularly large, it may be necessary to remove as much of the damaged and contaminated muscle as possible using a surgical procedure called debridement.

Debridement involves cleaning an open wound by removing foreign material, such as dirt and manure, as well as any dead tissue. In the case of a tetanus infection, debridement will remove any remaining tetanus bacteria.

Nutrition and breathing

The increased muscle activity caused by tetanus means that a person with the infection needs to consume a high amount of calories. An intake of 3,500 to 4,000 calories a day is often required, plus 150g of protein a day.

If swallowing is difficult or not possible, it may be necessary to give a liquid feed through a tube connected to the stomach or through a drip into a vein. Help with breathing may also be required using a ventilator (a machine that helps you breathe).

Complications

If a tetanus infection is severe, several possible complications can develop.

Sudden cardiac death

Sudden cardiac death is the most serious complication of tetanus. It is a leading cause of death in people with the condition.

Sudden cardiac death is where the heart suddenly stops beating. It can occur for a variety of reasons and usually only happens in people who are already very ill with tetanus (in an intensive care unit).

Sudden cardiac death is not the same as a heart attack, which is where the flow of blood to the heart becomes restricted, causing the muscles of the heart to become damaged.

Pulmonary embolism

Like all very ill people, people with tetanus are at risk of a pulmonary embolism.

A pulmonary embolism is a serious and potentially life-threatening condition. It is caused by a blockage in a blood vessel in the lungs that can affect breathing and circulation. Therefore, it is vital that anti-clotting medication and, if necessary, oxygen therapy are given immediately.

Aspiration pneumonia

As people with tetanus have difficulty swallowing (dysphagia) because of muscle stiffness and spasms, there is a risk that small amounts of saliva could fall down into their lungs. This can cause an infection known as aspiration pneumonia.

Aspiration pneumonia is treated with antibiotics.

Acute kidney failure

The severe muscle spasms associated with a tetanus infection can cause a condition known as rhabdomyolysis.

In rhabdomyolysis, muscle tissues are broken down, causing a protein called myoglobin to leak into the urine. This can cause acute kidney failure, where the kidneys suddenly lose most or all of their functions.

For more health articles, information or to use our symptom checker click here